Freed Gary L, Nahra Tammie A, Wheeler John R C
Child Health Evaluation and Research Unit, the Division of General Pediatrics, University of Michigan, Ann Arbor, 48109-0456, USA.
Arch Pediatr Adolesc Med. 2004 Jan;158(1):22-6. doi: 10.1001/archpedi.158.1.22.
Although pediatricians and family physicians are trained in the care of children, previous studies have revealed significant differences in the medical care and specialty referral patterns each provides. During the 1990s, several developments in the population and the health care system (eg, aging of the population and increases in Medicaid managed care) may have resulted in changes to the proportion of children seeking care from one or the other specialty.
To determine any changes in the proportion of office visits for children from birth through the age of 17 years provided by pediatricians or family physicians from 1980 to 2000.
Analysis of the National Ambulatory Medical Care Survey data sets from 1980 to 2000. During our years of interest, the total number of visits sampled ranged from 2524 to 9151. Visits were analyzed for physician type and patient age.
There have been marked changes in the proportion of office visits to general pediatricians vs family physicians during the 1990s. Overall, the percentage of all nonsurgical physician office visits for children from birth through the age of 17 years made to general pediatricians increased significantly, from 56.2% in 1990 to 64.2% in 2000 (P<.001). During the same period, the percentage of all nonsurgical physician office visits for children from birth through the age of 17 years made to family physicians declined significantly, from 33.7% in 1990 to 23.9% in 2000 (P<.001). Visits to pediatric specialists, as a proportion of all visits, increased significantly, from 1.6% in 1980 to 4.5% in 2000 (P<.001).
Pediatricians are providing more primary care visits for children in the United States, and this trend has accelerated during the past 5 years. These findings have implications for the cost of care, the physician workforce, and the training of future physicians. It is unknown if these changes have had a positive or negative impact on the health of our nation's children.
尽管儿科医生和家庭医生都接受过儿童护理方面的培训，但先前的研究表明，他们各自提供的医疗服务和专科转诊模式存在显著差异。在20世纪90年代，人口和医疗保健系统出现了一些变化（例如，人口老龄化和医疗补助管理式医疗的增加），这可能导致了从这两个专科中寻求医疗服务的儿童比例发生变化。
确定1980年至2000年期间，儿科医生或家庭医生为从出生到17岁的儿童提供门诊服务的比例有何变化。
对1980年至2000年的国家门诊医疗调查数据集进行分析。在我们关注的这些年份里，抽样的就诊总数在2524至9151次之间。对就诊情况按医生类型和患者年龄进行分析。
在20世纪90年代，普通儿科医生与家庭医生的门诊就诊比例发生了显著变化。总体而言，从出生到17岁的儿童在所有非手术医生门诊就诊中，看普通儿科医生的比例显著增加，从1990年的56.2%增至2000年的64.2%（P<0.001）。同期，从出生到17岁的儿童在所有非手术医生门诊就诊中，看家庭医生的比例显著下降，从1990年的33.7%降至2000年的23.9%（P<0.001）。儿科专科医生的就诊比例在所有就诊中显著增加，从1980年的1.6%增至2000年的4.5%（P<0.001）。
在美国，儿科医生为儿童提供的初级保健就诊服务增多，且这一趋势在过去5年中加速。这些发现对医疗成本、医生劳动力以及未来医生的培训都有影响。目前尚不清楚这些变化对我国儿童健康产生了积极还是消极的影响。
